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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK blONffORING PLAN-(Page I of 2) TYPE OF ACTION [11.NEW PLAN 2.CHANGE OF INFORMATION 490-1 PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) IS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- FACILITY YSTEMS)FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) � % 3'-. Cowl,P ,c BUSINESS SITE ADDRESS 103' 1 CITY . G /) 104. f' II EQUIPI�IENT_TRSTINGAND E Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line teak detectors,etc.)must be performed at the frequency specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. 23 CCR_§26.32.2634y2638 2, 641) 490.3a MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER Q (Specify): 490-36 III M�NITORIIYG LQGA,' IQNS........ ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49D-4 IV TAI�(K MONS TOR�IYG Is PI*;RFORMD USING TIiI•!FOO,_WI1�G,METHO� $ ❑ 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY b.LIQUID FILLED ❑ c.PRESSURIZED Eld_.UNDER VACUUM 49°s -- - - --- - - - - _ -- - ----- ------- ------ --- PANEL MANUFACTURER:- � - � �' - - 490 7'j MODEL#: LEAK SENSOR MANUFACTURER: MODEL#(W41, �3 z0 to ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§26,43)l 190-11 PANEL MANUFACTURER: 490.11 MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: _ _ -490-t0-. _MODEL#(S)__ -------------------------------------------------------------------------------------------- - - --------------------•-- LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490.16 ❑ d.MONTHLY ❑ e.OTHER(Specify): °9x17 ----------- ------------------- - --- - - ------------------ -- -- --- - -- - -- - - - - - -- - d4---- PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490.19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490.20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49900.22 5.TANK INTEGRITY,TF G(23 CCR§2643.1): 490'23 TEST FREQUENCY: t(a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHEReci 490-24 {S P fY)� 490•25 El99.OTHER (Specify): 490-26 490-Z7 MOMTORIN IS ,ERFORMEI)iJSING I III'<kQI.�OFIVT (G ME'I HODS)(Cheek all that apply) . . L CONTINUOUS MONITORING OF P E/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-26 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS: DRY ❑b.LIQUID F_[LLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 0-90-29 PANEL MANUFACTURER: Gy - ------490-30 - MODEL#, ----- - 490.31 LEAK SENSOR MANUFACTURER: 490 32_ MODEL#(S-,t r- 490.33 --- ----- PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. �a. ES ❑b.NO 490.34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. YES ❑b.NO 490-35 ❑ 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p_h-LEAK TEST AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS 490.36 MLLD MANUFACTURER(S): 490-37 MODEL#(S): 490-38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) - 490-39 ---------------------------------------------------------------------------------------------------___-------------- ----__-__._.----- ELLD MANUFACTURER(S) 40 MODEL#S: 490-41 --------------- - - - ---- - - -- --- __- --- --- --- - ---- �--- - --- -- - ---- - PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49D-43 ELLD FAILURE/DISCONNfQTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490'44 ❑ 4.PIPE INTEGRITY TF,. NG 490-45 TEST FREQUENCY Q ANNUALLY Cj b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46 490.47 ❑ 5.VISUAL PIPE MONI-MRING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 •Allowed ror monitoring of unburied emagmcy gggemor fuel Piping only r HSC 25281.5 b 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 490-50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTE 490.51 ❑ 99.OTHER(Specify) . 53 UPCF UST-D(12/2007)1/4 i